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General NPI Number Information
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NPI Number | 1851931927
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Entity Type | Organization
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Legal Business Name | THE SPACE: A COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 11 E BEVERLEY ST STE 9
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City | STAUNTON
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State | VA
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Zip | 24401-4364
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Country | US
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Telephone | 251-272-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 11 E BEVERLEY ST STE 9
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City | STAUNTON
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State | VA
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Zip | 24401-4364
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Country | US
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Telephone | 251-272-9460
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRISHA MCKEITHEN
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Credential | LPC
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Telephone | 251-272-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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